Kidney diseases Flashcards by Christina Wilson

What is glomerulonephritis?

Non-infective inflammation of the glomeruli of the kidney, often with an immunological cause

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What is pyelonephritis?

Bacterial infection of renal pelvis, calyces, tubules and interstitium

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What is the most common causative organism of pyelonephritis?

E. coli

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Which gender is pyelonephritis more common in?

Female

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How does pyelonephritis occur?

Infection from haematogenous spread

Ascending infection

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What are the risk factors for pyelonephritis?

Urinary tract obstruction

Vesico-ureteric reflux

Diabetes

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What would indicate chronic pyelonephritis

Symptoms often vague

Hypertension/uraemia

Large volume of urine

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What would be seen on imaging of the kidney in chronic pyelonephritis?

Coarse cortical scarring

Distortion of calyces

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What is chronic pyelonephritis associated with?

Chronic kidney disease

Hypertension

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What are the symptoms of tubercular pyelonephritis?

Weight loss

Fever

Loin pain

Dysuria

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How does tuberculosis normally reach the kidney?

Haematogenous spread from lung

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What is sterile pyruria and what disease does it occur in?

Tubercular pyelonephritis

Pus in urine, but doesn’t grow organisms on culture because TB takes weeks to grow in special medium

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What pathology might be seen in tubercular pyelonephritis?

Caseous foci – slow growth with progressive renal destruction

Spread to ureters, bladder and other viscera

Typical caseating granulomatous inflammation

Mycobacteria may be seen on histological special stains (Zeehl-Neilsen) but absence does not exclude TB

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What bacteria cause cystitis?

E. Coli.

Klebsiella

Proteus

Pseudomonas

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What is cystitis?

Inflammation of the bladder caused by a urine infection

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Why is cystitis associated with outflow obstruction particulary dangerous?

Can become necrotising if associated with outlet obstruction

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What is ureteritis/cystitis cystica?

Multiple small fluid filled cysts projecting into lumen as a result of chronic inflammation/irritation

Can resemble tumours

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What organism can predispose to malignancy, particularly squamous cell carcinoma of the bladder?

S. Haematobium - schistosomiasis

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What can be a result of prolonged bladder outlet obstruction?

Hypertrophy of the detrusor muscle, which can cause diverticular formation

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Which problem in neonates can cause urethral outflow obstruction?

Posterior urethral valves

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What is hydronephrosis?

Dilatation of pelvicalyceal system with parenchymal atrophy

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What are the main causes of hydronephrosis?

Urinary tract obstruction

Reflux

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What is this?

Hydronephrosis

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What is the most common cause of urinary outflow obstruction in the elderly male?

Prostatic enlargement or tumour

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What is the inheritance pattern of adult polycystic kidney disease?

Autosomal dominant Abnormality on chromosome 16

How does adult polycystic kidney disease usually present?

Middle age Abdominal mass Haematuria Hypertension Chronic renal failure Fatigue

What are the pathological characteristics of adult polycystic kidney disease?

Massive bilateral renal enlargement Multiple cysts of varying size Distortion of reniform shape Cysts arise in any part of nephron

What other extrarenal complications is adult polycystic kidney disease associated with?

Cysts in liver, pancreas, lung Association with berry aneurysm in the circle of Willis

What is the significance of increased risk of berry anuerysms associated with polycystic kidneys?

Increased risk of subarachnoid haemorrhage

Where are fibroma found in the kidney and what is their appearance?

Medulla White nodules

Where are adenoma found in the kidney and what is their appearance?

Cortex Yellowish nodules \<2cm

What is angiomyolipoma and where might they be in the kidney?

Mixture of fat, muscle and blood vessels Can be multiple and bilateral

What disease is angiomyolipoma associated with?

Tuberous sclerosis

How might a juxtaglomerular cell tumour present?

Secondary hypertension due to increased renin

What is the most common intra-abdominal tumour in children and from which tissue does it arise?

Nephroblastoma (Wilms’ Tumour) Arises from residual primitive renal tissue

What is the commonest primary renal tumour in adults?

Renal cell carcinoma

What age and gender does renal cell carcinoma usually present in?

Age 55-60 M:F 2:1

How does renal cell carcinoma present?

Abdominal mass Haematuria Flank pain General features of malignant disease

What are the paraneoplastic manifestations of renal cell carcinoma?

Polycythaemia (overproduction of red blood cells) Hypercalcaemia

Where do renal cell carcinomas arise and what is their appearance?

Large, well circumscribed mass on the cortex Yellow colour, with solid, cystic, necrotic and haemorrhagic areas

Where do renal cell carcinomas commonly extend into?

Renal vein Can continue into vena cava and right atrium

How does renal cell carcinoma usually spread and to where?

Through blood To lung and bone

What is the most common cell type in renal cell carcinoma and what are these cells?

Clear cell Tumour cells rich in glycogen and lipid

Which type of carcinoma affects the renal pelvis?

Transitional cell carcinoma

What imaging is used to diagnose renal cell carcinoma?

Ultrasound Triple phase contrast CT

What system is used to stage renal cell carcinoma?

Robson staging

What surgical treatments are there for renal cell carcinoma?

Radical nephrectomy Partial nephrectomy Radiofrequency ablation

What is the definition of chronic kidney disease?

Chronically reduced GFR and evidence of kidney damage

How can GFR be estimated?

Creatinine clearance

Why is creatinine clearance only an estimate of GFR?

Secreted from tubules Increased in muscular people Needs to be stable - fluctuates during illness in hospital Requires 24 hour urine collection which is often done inaccurately

What is the definition of stage 1 chronic kidney disease?

GFR \> 90ml/min with evidence of kidney damage

What is the definition of stage 2 chronic kidney disease?

GFR 60-90ml/min with evidence of kidney damage

What is the definition of stage 3 chronic kidney disease?

GFR 30-60ml/min (1 in 20 people will have a GFR like this normally)

What is the definition of stage 4 chronic kidney disease?

GFR 16-30ml/min

What is the definition of stage 5 chronic kidney disease?

GFR \<15ml/min or renal replacement therapy

Which factors indicate that someone is more likely to progress to a higher stage of chronic kidney disease?

Proteinuria Younger age at onset

What is the most common cause for requirement of dialysis?

Diabetic nephropathy

What are the common causes of CKD?

Diabetes Hypertension Vascular disease Chronic glomerulonephritis Reflux nephropathy Polycystic kidneys

When do symptoms usually present in chronic kidney disease?

Late: GFR usually \<20ml/min

What are the symptoms of chronic kidney disease?

Tiredness Poor appetite Itch Sleep disturbance Impaired urinary concentrating ability – symptoms may occur earlier - nocturia

How is progression of CKD slowed?

Reducing proteinuria and managing blood pressure: ACEi/ARBs do both Spironolactone Stopping smoking Managing diabetes

What side effects must you be aware of when starting a patient on ACEi or spironolactone for CKD?

Initial fall in GFR Hyperkalaemia

Why does anaemia occur as a side effect of CKD?

Erythropoietin produced by the kidneys and production declines in CKD

Why is bone disease a complication of CKD?

Vitamin D hydroxylated in the kidney - impaired in CKD Leads to reduced calcium absorption, leading to secondary hyperparathyroidism In advanced CKD, serum phosphate rises – also increases PTH secretion

What can result from high phosphate and high calcium?

Calcified vessels and heart valves

How is bone disease treated in relation to CKD?

Alfacalcidol Advice on phosphate intake Phosphate binders

What is reflux nephropathy?

Angles of the ureters fail to shut the valves properly, causing reflux Kidneys become small and scarred due to vesico-ureteric reflux Sometimes called chronic pyelonephritis

Which patients is reflux nephropathy most common in?

Children

When do hepatic cysts associated with polycystic kidneys tend to arise?

10 years after kidney disease

What cardiac disease is associated with polycystic kidney disease?

Mitral/aortic valve prolapse Valvular disease

What GI disease is polycystic kidney disease associated with?

Diverticular disease Diverticulitis and perforation are 2 important complications

How should polycystic kidney disease be managed?

Rigourous control of hypertension Hydration Proteinuria reduction

Where are cysts seen coming from in autosomal recessive polycystic kidney disease?

Seen appearing from the collecting system

Which pattern of inheritance is Alports syndrome?

X-linked recessive

What is Alports syndrome?

An inherited nephritis caused by a defect in type IV collagen matrix

What are the renal manifestations of Alports syndrome?

Haematuria initially Proteinuria later

What renal manifestation is a bad prognostic sign in Alports disease?

Proteinuria

What are the extra-renal manifestations of Alports syndrome?

Sensorineural deafness Ocular defects-anterior lenticonus Leiomyomatosis of oesophagus/genitalia-rare

What is the characteristic feature on biopsy of Alports syndrome?

Variable glomerular basement membrane thickness

What is Anderson-Fabrys disease?

An X linked disease lysosomal storage disease affecting kidneys, liver, lungs and erythrocytes